Related to Mental Health

Hoarding: More Than Just a Mess

Hoarding is a common problem that is difficult to treat.

By Eric Metcalf, MPH

From the WebMD Archives

Judith Kolberg is accustomed to walking into cluttered homes. As a professional organizer, the Decatur, Ga., woman helps clients straighten messy closets, tame stacks of paperwork, and bring order to their chaos.

In the past 25 years, she’s also entered the homes of about a dozen people who could be diagnosed as hoarders -- and countless others who came close.

“It’s a pretty sensory experience, let me put it that way. There’s obviously the assault on your eyes of the quantity of the clutter, then there’s the appreciation of what a mishmash the clutter is. Sometimes there’s more than your average share of odor, dust, mold, or other types of structural damage,” she says.

This problem has gained wider visibility in recent years, thanks in part to several hoarding-related television shows. Two percent to 5% of Americans may meet the criteria for being hoarders, says psychologist David Tolin, PhD, a hoarding specialist and author of Buried in Treasures. “Panic disorder might affect 1%, and obsessive-compulsive disorder maybe 2%. We’re talking about a surprisingly common disorder that had never really been recognized,” he tells WebMD.

Hoarding’s effects can extend beyond an overstuffed home. It can put people’s health at risk. It can damage families. It can affect surrounding neighborhoods. And treating it requires more than a big box of trash bags.

The Root of Hoarding: What Lies at the Bottom of That Pile

Experts usually draw the line between a merely messy lifestyle and hoarding “when it comes to the person’s ability to function,” Tolin says. “Lots of people may acquire things they don’t need, but if it’s not the sort of thing that causes an inability to function adequately, we don’t call it hoarding. If they’re no longer able to cook meals in their own home, if they can’t live safely in their own home, if they’re a threat to others, that’s where we’d say it crosses the line.”

People may hoard objects for many reasons, says Michael Tompkins, PhD, a psychologist and co-author of Digging Out: Helping Your Loved One Manage Clutter, Hoarding, and Compulsive Acquiring. These include:

An intense emotional attachment to objects that others see as trivial -- or even trash. They’d feel a sense of major loss if they had to throw this stuff away.

A sense that many items have an intrinsic value, like others might see in artwork or driftwood.

The assumption that an item might be useful someday, which compels them to save far more than “the drawer of hinges, thumbtacks, string, and rubber bands” that many of us keep.

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In the past, experts saw hoarding as an “an outgrowth of obsessive-compulsive disorder (OCD)," Tolin tells WebMD. “But as we have more studies coming in, we’re increasingly seeing that it’s not. It seems like there is not a particular special or strong relationship with OCD. Much more common are problems like major depression disorder, anxiety, and attention deficit disorder.”

Studies have found that the frontal lobe within the brain of someone who hoards tends to work differently, he says. This region is crucial for weighing options and thinking rationally. As a result, their priorities are different from those of non-hoarders, and “those are things we can imagine might feed into a hoarding problem,” Tolin says.

Sifting Through a Hoarding Problem

Most people who hoard don’t seek help on their own, Tompkins says. Sometimes they come in under pressure from their family, but in most cases it’s the family members themselves who seek help in bringing the home under control. Sometimes, people must take action because a landlord, a condominium association, or the city has put pressure on them to clean up the mess.

TV viewers may breathe a sigh of relief when they see a tidy, spacious home -- or room of a home -- at the end of a hoarding program. But solutions aren’t often simple, quick, or lasting. “It’s a very difficult syndrome to break,” says Kolberg, who offers training for other organizers to help them deal with clients who hoard.

“I think you want to keep in mind that no amount of shaming them or yelling at them or having temper tantrums about it is really going to change the issue. It’s important for hoarders to realize they’re causing other people harm and stress. I get that. But hammering away at them for behaving this way is just not helpful,” she says.

Expecting to see a substantial portion of the floors and tabletops in the near future may not be realistic, either.

“Obviously there are success stories, but it’s important to recognize that this is a chronic and severe problem. When it comes to chronic and severe problems -- like drug use, bipolar disorder, severe depression, or hoarding -- even with best of treatment, a lot of people will still be struggling,” Tolin says.

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Therapy for Hoarding

Tolin and Tompkins suggest an approach called cognitive behavioral therapy (CBT). This treatment teaches people to see the objects around them in a new light and to change their hoarding behaviors. Tompkins says that CBT sessions can help a hoarding client:

Make more reasonable judgments when deciding if an object is worthy of keeping or not

Learn how to make quick decisions on whether to keep an object or toss it

Practice discarding items while sorting through the intense emotions they trigger

Since most hoarders don’t seek help -- and those who do tend to have trouble changing -- experts often also focus on an approach called "harm reduction," Tompkins says. This can help cut down on vermin, fire hazards, and other threats to the hoarder and the community.

“Harm reduction, as applied to hoarding, assumes that the behavior will continue, and so long as the behavior continues, what we try to design is a plan that reduces the risk that the person and the community face from the behavior," Tompkins says.

Pairing a mental health professional with an organizer can be helpful, Kolberg says. An organizer can guide people toward understanding the benefits of changing their habits, then setting goals to help them tame the mess.

“When you put people in touch with their goals, then you have something to work with,” she says. “Then you can say [to the hoarder], ‘I thought we were working toward this goal,' when [the hoarder] objected to my saying, 'Are you sure you need to hang onto that? It’s a comb without teeth.' Does keeping it help you toward your goal?’"